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Consumer satisfaction, quality of life and distress with regard to social function and gender in severe mental illness

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DOI: 10.4236/ojpsych.2011.13013    4,088 Downloads   7,609 Views   Citations


OBJECTIVE. The relationships between subjective satisfaction, distress and quality of life for severely mental ill patients with different functional levels and gender was investigated in a multi-center cohort, using a balanced mix of subjective and clinician ratings in an outcome-informed model for a clinical management based on shared decision making, "The Quality star". METHODS. Naturalistic data for 2552 persons, mainly with schizophrenia diagnoses, in long-term treatment and rehabilitation, were analyzed in a cross-sectional study. RESULTS. With increasing Social Function, rated with the split-GAF Disability/Functioning scale, the better were patients' Satisfaction, subjective Quality of life and Perceived Global Distress. Women were more satisfied with the care but also more distressed. CONCLUSION. Main findings were in line with other studies. However, the gender differences are in line with some, but not with other, studies. This poses questions how patient factors, instrument constructs, and treatment, especially shared decision making, influence subjective reports.

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The authors declare no conflicts of interest.

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Ivarsson, B. , Lindström, L. , Malm, U. and Norlander, T. (2011) Consumer satisfaction, quality of life and distress with regard to social function and gender in severe mental illness. Open Journal of Psychiatry, 1, 88-97. doi: 10.4236/ojpsych.2011.13013.


[1] Roeling, M.P. (2010) Functioning is the cornerstone of life. Journal of European Psychology Students, 2, 1-14.
[2] Burns, T. and Patrick, D. (2007) Social functioning as an outcome measure in schizophrenia studies. Acta Psychiatric Scand, 116, 403-418. doi:10.1111/j.1600-0447.2007.01108.x
[3] Salloum, I.M. and Mezzich, J.E. (2009) Psychiatric diagnosis: Challenges and prospects. Wiley-Blackwell, Oxford.
[4] Regier, D.A., Narrow, W.E., Kuhl, E.A. and Kupfer, D.J. (2009) The conceptual development of DSM-V. American Journal of Psychiatry, 166, 645-650. doi:10.1176/appi.ajp.2009.09020279
[5] Flanagan, E.H., Davidson, L. and Strauss, J.S. (2010) The need for patient-subjective data in the dsm and the ICD. Psychiatry, 73, 297-307. doi:10.1521/psyc.2010.73.4.297
[6] Sorgaard, K.W., Heikkila, J., Hansson, L., Vinding, H.R., Bjarnason, O., Bengtson-Tops, A., et al. (2002) Self-eteem in persons with schizophrenia. A Nordic multicentre study. Journal of Mental Health, 11, 405-415. doi:10.1080/09638230020023769
[7] Mattsson, M., Lawoko, S., Cullberg, J., Olsson, U., Hansson, L. and Forsell, Y. (2005) Background factors as determinants of satisfaction with care among first-episode psychosis patients. Social Psychiatry Psychiatric Epidemiology, 40, 749-754. doi:10.1007/s00127-005-0945-7
[8] Ruggeri, M., Lasalvia, A., Bisoffi, G., Thomicroft, G., Vazquez-Barquerot, J.L., Becker, T., et al. (2003) Satisfaction with mental health services among people with schizo-phrenia in five european sites: Results from the epsilon study. Schizophrenia Bulletin, 29, 229-245.
[9] Helldin, L., Kane, J., Karilampi, U., Norlander, T. and Archer, T. (2008) Experience of quality of life and attitude to care and treatment in patients with schizophrenia: Role of cross-sectional remission. International Journal of Psychiatric Clinical Practice, 12, 97-104. doi:10.1080/13651500701660007
[10] Malm, U., Ivarsson, B., Allebeck, P. and Falloon, I.R.H. (2003) Integrated care in schizophrenia: A 2-year randomized controlled study of two community-based treatment programs. Acta Psychiatrica Scandinavica, 107, 415-423. doi:10.1034/j.1600-0447.2003.00085.x
[11] Priebe, S., McCabe, R., Bullenkamp, J., Hansson, L., Lauber, C., Martinez-Leal, R., et al. (2007) Structured patient clinician communication and 1-year outcome in community mental healthcare: Cluster randomised controlled trial. British Journal of Psychiatry, 191, 420-426. doi:10.1192/bjp.bp.107.036939
[12] McCabe, R., Saidi, M. and Priebe, S. (2007) Patient-reported outcomes in schizophrenia. British Journal of Psychiatry, 191, 21-28. doi:10.1192/bjp.191.50.s21
[13] Hafner, H. (2003) Gender differences in schizophrenia. Psychoneuroendocrinology, 28, 17-54. doi:10.1016/S0306-4530(02)00125-7
[14] Nasser, E.H., Walders, N. and Jenkins, J.H. (2002) The experience of schizophrenia: What’s gender got to do with it? A critical review of the current status of research on schizophrenia. Schizophrenia Bulletin, 28, 351-362.
[15] Erdner, L. and Ivarsson, B. (2002) The quality star—A tool for regular outcome monitoring. Cambridge, UK, 65-69.
[16] Ivarsson, B., Erdner, L. and Malm, U. (2006) The quality star—An algorithm for the evaluation of mental health services. Presentation for ENMESH conference, Lund, Sweden 10 June, URL (last checked 21 March 2011)
[17] Burns, T. and Firn, M. (2002) Assertive outreach in mental health, a manual for practitioners. Oxford University Press, Oxford.
[18] Malm, U. (2002) Case management, studentlitteratur. Lund, Sweden.
[19] Falloon, I.R.H., Montero, I., Sungur, M., Mastroeni, A., Malm, U., Economou, M., et al. (2004) Implementation of evidence-based treatment for schizophrenic disorders: Two-year outcome of an international field trial of optimal treatment. World Psychiatry, 3, 104-109.
[20] Pedersen, G., Hagtvet, K.A. and Karterud, S. (2007) Generalizability studies of the global assessment of functioning—split version. Comprehensive Psychiatry, 48, 88-94, 2007. doi:10.1016/j.comppsych.2006.03.008
[21] Hjarthag, F., Helldin, L. and Norlander, T. (2008) Family burden: Psychometric properties of the burden inventory for relatives to persons with psychotic disturbance. Psychological Reports, 103, 323-335.
[22] Ivarsson, B. and Malm, U. (2007) Self-reported consumer satisfaction in mental health services: Validation of a self-rating version of the UKU-consumer satisfaction rating scale. Nordic Journal of Psychiatry, 61, 194-200. doi:10.1080/08039480701352488
[23] Ivarsson, B., Malm, U., Lindstrom, L. and Norlander, T. (2010) The self-assessment global quality of life scale—Reliability and construct validity. International Journal of Psychiatric Clinical Practice, 14, 287-297. doi:10.3109/13651501.2010.487217
[24] Ivarsson, B., Lindstrom, L., Malm, U. and Norlander, T. (2011) The self-assessment perceived global distress scale—Reliability and construct validity. Psychology, 2, 283-290. doi:10.4236/psych.2011.24045
[25] Nordén, T., Ivarsson, B., Malm, U. and Norlander, T. (2011) Gender and treatment comparisons: Consumer satisfaction, quality of life, function and symptoms in a cohort of patients with psychiatric diagnoses. Social Behavior and Personality, 39, 1037-1086. doi:10.2224/sbp.2011.39.8.1073
[26] Everitt, B.S. and Wykes, T. (1999) A dictionary for statistics for psychologists. Arnold, London.
[27] GGG manual and instruments (2009) GGG-group of the quality star network. instruments and manual, original Swedish version. URL (last checked 21 March 2011), present English version published by Karlstad university in cooperation with the Quality Star Network. Available through authors.
[28] APA (American Psychiatric Association). (2002) Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR). American Psychiatric Press, Washington, DC.
[29] Patterson, D.A. and Lee, M.S. (1995) Field trial of the global assessment of functioning scale-modified. American Journal of Psychiatry, 152, 1386-1388.
[30] Yamauchi, K., Ono, Y., Baba, K. and Ikegami, N. (2001) The actual process of rating the global assessment of functioning scale. Comprehensive Psychiatry, 42, 403-409. doi:10.1053/comp.2001.26268
[31] Soderberg, P. and Tungstrom, S. (2007) Outcome in psychiatric outpatient services. Reliability, validity and outcome based on routine assessments with the GAF scale. Umea: Department of Psychology, Umea University, Sweden.
[32] Aas, I.H.M. (2010) Global Assessment of Functioning (GAF): Properties and frontier of current knowledge. Annals of General Psychiatry, 9, 20. doi:10.1186/1744-859X-9-20
[33] Aas, I.H.M. (2011) Guidelines for rating Global Assessment of Functioning (GAF). Annals of General Psychiatry, 10, 2. doi:10.1186/1744-859X-10-2
[34] Duncan, B.L., Miller, S.D., Wampold, B.E. and Hubble, M.A. (2009) The heart and soul of change, second edition: Delivering what works in therapy. American Psychological Association, Washington DC.
[35] Eklund, M. and Hansson, L. (2001) Determinants of satisfaction with community-based psychiatric services: A cross-sectional study among schizophrenia outpatients. Nordic Journal of Psychiatry, 55, 413-418. doi:10.1080/08039480152693318
[36] Ito, H. and Sederer, L.I. (2001) Are publicly-insured psychiatric outpatients in Japan satisfied? Health Policy, 56, 205-213. doi:10.1016/S0168-8510(01)00116-6
[37] Garety, P.A., Craig, T.K.J., Dunn, G., Fornells-Ambrojo, M., Colbert, S., Rahaman, N., et al. (2006) Specialised care for early psychosis: Symptoms, social functioning and patient satisfaction, randomised controlled trial. British Journal of Psychiatry, 188, 37-45. doi:10.1192/bjp.bp.104.007286
[38] Brissos, S., Balanza-Martinez, V., Videira, D.V., Carita, A.I. and Figueira, M.L. (2011) Is personal and social functioning associated with subjective quality of life in schizophrenia patients living in the community? Europe Arch Psychiatry Clinical Neuroscience, Published on-line 08 March 2011. doi:10.1007/s00406-011-0200-z
[39] Melle, I., Larsen, T.K., Haahr, U., Friis, S., Johannesen, J.O., Opjordsmoen, S., Rund, B.R., Simonsen, E., Vaglum, P. and McGlashan, T. (2008) Prevention of negative symptom psychopathologies in first-episode schizophrenia. Two-year effects of reducing the duration of untreated psychosis. Arch General Psychiatry, 65, 634-640. doi:10.1001/archpsyc.65.6.634
[40] Petersen, B., Toft, J., Christensen, N.B., Foldager, L., Munk-Jorgensen, P., Lien, K., et al. (2008) Outcome of a psychotherapeutic programme for patients with severe personality disorders. Nordic Journal of Psychiatry, 62, 450- 456. doi:10.1080/08039480801984271
[41] Jorgensen, K.N., Romma, V. and Rumdmo, T. (2009) Associations between ward atmosphere, patient satisfaction and outcome. Journal of Psychiatric and Mental Health Nursing, 16, 113-120. doi:10.1111/j.1365-2850.2008.01333.x
[42] Kusel, Y., Laugharne, R., Perrington, S., McKendrick, J., Stephenson, D., Stockton-Henderson, J., et al. (2007) Measurement of quality of life in schizophrenia: A comparison of two scales. Social Psychiatry Psychiatric Epidemiolgdy, 42, 819-823. doi:10.1007/s00127-007-0249-1
[43] Brekke, J.S. and Long, J.D. (2000) Community-based psychosocial rehabilitation and prospective change in functional, clinical, and subjective experience variables in schizophrenia. Schizophrenia Bulletin, 26, 667-680.
[44] Faerden, A., Friis, S., Agartz, I., Barrett, E.A., Nesvag, R. and Finset, A., et al. (2009) Apathy and functioning in first-episode psychosis. Psychiatric Services, 60, 1495- 1503. doi:10.1176/
[45] Faerden, A., Finset, A., Friis, S., Agartz, I., Barrett, E.A., Nesvag, R., et al. (2010) Apathy in first episode psychosis patients: One year follow up. Schizophrenia Research, 116, 20-26. doi:10.1016/j.schres.2009.10.014
[46] Engh, J.A., Friis, S., Birkenaes, A.B., Jónsdóttir, H., Klungsoyr, O., Ringen, P.A., et al. (2010) Delusions are associated with poor cognitive insight in schizophrenia. Schizophrenia Bulletin, 36, 830-835. doi:10.1093/schbul/sbn193
[47] Lykke, J., Hesse, M., Austin, S.F. and Oestrich, I. (2008) Validity of the BPRS, the BDI and the BAI in dual diagnosis patients. Addictive Behaviors, 33, 292-300. doi:10.1016/j.addbeh.2007.09.020
[48] Svindseth, M.F., N?ttestad, J.A., Wallin, J., Roaldset, J.O. and Dahl, A.A. (2008) Narcissism in patients admitted to psychiatric acute wards: Its relation to violence, suicidality and other psychopathology. BMC Psychiatry, 8, 13. doi:10.1186/1471-244X-8-13
[49] Bj?rngaard, J.H., Ruud, T., Garratt, A. and Hatling, T. (2007) Patients ‘experiences and clinicians’ ratings of the quality of outpatient teams in psychiatric care units in Norway. Psychiatric Services, 58, 1102-1107. doi:10.1176/
[50] Gigantescoa, A., Picardia, A., Chiaiab, E., Balbib, A. and Morosini, P. (2002) Patients’ and relatives’ satisfaction with psychiatric services in a large catchment area in Rome. European Psychiatry, 17, 139-147. doi:10.1016/S0924-9338(02)00643-0
[51] Thornicroft, G., Leese, M., Tansella, M., Howard, L., Toulmin, H., Herran, A., et al. (2002) Gender differences in living with schizophrenia, a cross-sectional European multi-site study. Schizophrenia Research, 57, 191-200. doi:10.1016/S0920-9964(01)00318-8
[52] Blenkiron, P. and Hammill, C.A. (2003) What determines patients’ satisfaction with their mental health care and quality of life? Postgraduate Medical Journal, 79, 337-340. doi:10.1136/pmj.79.932.337
[53] Eiman, G. and Ivarsson, B. (2011) Provning av kvalietsstjarnan inom nysam GAF-project 2002-2004, “Quality Star Test within the nysam GAF project 2002-2004,” Nysam Adult Psychiatry Development Group, 2004. URL (last checked 21 March 2011)
[54] Lindstrom, E., Jedenius, E. and Levander, S. (2009) A symptom self-rating scale for schizophrenia (4S): Psychometric properties, reliability and validity. Nordic Journal Psychiatry, 63, 368-374. doi:10.1080/08039480902807298
[55] Priebe, S., Reininghaus, U., McCabe, R., Burns, T., Eklund, M., Hansson, L., et al. (2010) Factors influencing subjective quality of life in patients with schizophrenia and other mental disorders: A pooled analysis. Schizophrenia Research, 121, 251-258. doi:10.1016/j.schres.2009.12.020
[56] Meijer, C.J., Koeter, M.W.J., Sprangers, M.A.G. and Schene, A.H. (2009) Predictors of general quality of life and the mediating role of health related quality of life in patients with schizophrenia. Social Psychiatry Psychiatric Epidemiology, 44, 361-368. doi:10.1007/s00127-008-0448-4
[57] Priebe, S., Kaiser, W., Huxley, P., Roder-Wanner, U.-U. and Rudolf, H. (1998) Do different subjective evaluation criteria reflect distinct constructs? Journal of Nervous & Mental Disease, 186, 385-392. doi:10.1097/00005053-199807000-00001

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